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Archive for the ‘Uncategorized’ Category

Peds Associates Asthma Follow Up

Please all be reminded that for known peds associates clinic pts there is a binder on the desk in the PED for next day follow up. Please only refer known clinic pts to them and have the residents follow the instructions on the top of the page to call in the pt to the clinic’s phone mail. Please let me know if you have any questions.

Written by phil

February 4th, 2014 at 11:43 pm

Posted in Uncategorized

Palliative Care Resources

A big thanks to all of you who joined our palliative care conference yesterday. I hope that you found it useful to your practice in the ED. For those of you interested in learning more about these topics, I created a list of resources that you may find helpful! Also, I’m attaching the “Goal Setting Conference” pocket card that we handed out yesterday.

Need quick, concise clinical info at the bedside (want to manage dyspnea in a dying patient, have a conversation about code status, prognosticate in a patient with advanced cancer…)

EPERC Fast Facts

Amazing resource for all things EM and pal care


Want to improve your communication skills? The site below was created for oncologists but the skill set is universal. Watch the videos for a great demonstration of these skills in action!


The creators of Oncotalk also wrote a terrific book, Mastering Communication with Seriously Ill Patients: balancing honesty with empathy and hope, if you want to go a step further.

Want to significantly improve your palliative care knowledge and skills?

EPEC-EM course

Written by phil

November 2nd, 2013 at 3:06 pm

Posted in Uncategorized

Animal Bites

From Dr. Fairweather,

If you report animal bites at the website below (located as a link from the ROL) you DO NOT also have to call the DOH. In fact, you should never call, simply use the link. At the Login prompt the ID is “doctor” and Password is “doctor”.

NYC Department of Health animal bites reporting: (212) 676-2483.
Maureen Flanagan-Jones, EHC Infection Prevention and Control 4-3079

Written by phil

August 30th, 2013 at 8:00 pm

Posted in Uncategorized

Palliative Care Consults

As some of you may know, our department had a difficult case earlier in the month in which we had trouble transferring a patient near the end of his life to the palliative care unit (PCU) because of procedural confusion about what is possible on overnights.

Gabi Goldberg, the medical director of the Palliative Care Unit, has summarized what our off-hours approach should be for such patients:

“[Mount Sinai does] not have any palliative care physicians present overnight. We have coverage by ADS [the general medical service] and the Rehab PA. If there are patients in the ED appropriate for the PCU, they may be admitted to [the PCU] by the ADS [general medical service] coverage and consulted on by the PCU team and taken on as primary as appropriate the following morning. This is true 7 days a week. In regards to hospice beds, VNS hospice admission nurses are available during business hours +Mon- +Fri with preference for scheduling of admissions in advance. We do allow a 24h window of stay on the PCU prior to hospice admission, but this does not prevent a hospital admission.”

Thus if you have a patient on a +Saturday overnight who would be a good candidate for the PCU and there is a bed available, discuss this plan with the patient’s PMD and the MAPA/MAR and your patient will be rounded on by the primary palliative care service that +Sunday morning. Let me know if you have any further problems.

The palliative care fellow should also be called if you think there’s a patient who’s appropriate for the PCU, even on weekends and in the evening. They need to be involved, for a variety of reasons. Confirmed with Gabi Goldberg.


Written by phil

March 27th, 2013 at 3:56 pm

Posted in Uncategorized

STEMI notifications

Hi Everyone,

A significant change to EMS Policy regarding STEMI was announced by FDNY and supported by the Regional EMS Advisory Committee on which I serve and takes effect today, February 1st.

There will NOT be a STEMI notification made for new or presumably new LBBB.
STEMI notifications will now ONLY be made if the ST elevations are greater than 2mm in two or more contiguous leads.
They will still direct STEMI’s greater than 1mm in two or more contiguous leads to PCI centers

Because we all complain about too many false positive activations!

What does this mean for you?

1. STEMI notifications will only be called for massive STEMI’s! You should call a STEMI alert through AMAC based on prehospital notification.

2. You must appreciate that you will receive pt’s having an acute STEMI with no advanced notification and must be prepared to mobilize resources quickly.
– As always, our nursing staff will rapidly triage these patients to the RESUS room.
– Physician staff should rapidly respond to the overhead page, receive handoff from the EMS Providers and call an AMAC STEMI alert if you agree with the ECG interpretation by the prehospital providers. You can repeat the ECG with our machines but only if you believe it is necessary and will not delay care.


Kevin G. Munjal, MD, MPH
Assistant Professor, Associate Medical Director of Prehospital Care,
Department of Emergency Medicine
Mount Sinai Medical Center

Written by phil

February 5th, 2013 at 8:51 pm

Posted in Uncategorized